PMC scores above average in hospital care

Pocono Medical Center scored above average in the majority of categories used by the federal government to evaluate hospital quality, according to a report released on Thursday.

DAN BERRETT

Pocono Medical Center scored above average in the majority of categories used by the federal government to evaluate hospital quality, according to a report released on Thursday.

The report — produced by the Centers for Medicare and Medicaid Services, an agency of the U.S. Department of Health and Human Services — details the performance of 4,500 hospitals across the country; the results are available on the department's Web site.

The data measures 21 different "core categories" of service, which are meant to indicate a hospital's quality. Specifically, the report looks at treatment given to patients suffering from heart attacks, heart failure and pneumonia, or undergoing surgery.

Using hospital records from July 2005 to June 2006, the report documents the percentage of patients who, say, have congestive heart failure and are given aspirin, beta blockers or inhibitors upon arrival and discharge, or pneumonia patients who are advised to stop smoking.

Pocono Medical Center bettered both state and national averages in 13 out of the 21 categories.

Dr. Howard Davis, the center's vice president for medical affairs, was glad the hospital scored above average, but he still saw room for improvement. "Obviously we want to be at 100 percent in all core categories," Davis said.

The East Stroudsburg medical center did score 100 percent in two categories. All of its heart attack patients received beta blockers upon discharge and every one of its pneumonia patients was evaluated for the level of oxygen in his or her blood. The 100 percent treatment scores were good enough to place the medical center in the top tier, or 10 percent, of the nation's hospitals.

But the center also fell short of state and national averages in five categories — three had to do with treatment of patients with pneumonia and two with surgery.

The center was able to document that only two-thirds of its surgery patients received preventative antibiotics one hour before going under the knife. This was 10 percentage points below state and national averages.

Administering antibiotics within an hour of surgery helps decrease the risk of surgical wounds becoming infected.

Davis said Pocono Medical Center's patients likely had been getting the antibiotics, but that the anesthesiologist was not logging the time correctly.

"We had the process in place," he said, "but the documentation wasn't there."

That has since been corrected, according to Davis. He said that the hospital's records since the last report show that all surgical patients had been given antibiotics within an hour of the procedure.

In the remainder of the categories, the center did not have enough patients for a statistically reliable comparison.

The goal of posting the results on-line was to give consumers a set of standard criteria to evaluate the quality of care they receive from hospitals.

The core measures were agreed upon by health care providers, consumer groups and government officials after several years of wrangling, according to the Associated Press.

But Davis saw the core measures as saying more about a hospital's management than its care. "The hospitals that do well in core measures have made an institutional commitment to quality," he said. "(The measures) been given more importance than they actually have."

They are also limited. "If somebody comes in with a heart attack and you gauge whether they got good care based on whether they got aspirin, that's a little ridiculous," Davis said. "What we're really doing is attacking the problem from the edges."

To Davis, a better standard of measurement would be complication rates, or tracking the rate at which things go wrong.

The federal government defended its use of the core measures, seeking to link them to patient health.

"These reports serve as a tool to help hospitals look more broadly at their outcomes and processes of care and identify ways to lower mortality risk for their patients." Leslie Norwalk, acting administrator for the Centers for Medicare and Medicaid Services, said in a statement.

Thursday's report also included data on death rates for heart attack and heart failure patients. These were adjusted for risk and previous health problems, so that hospitals treating needier patients would not be penalized.

The 30-day national death rate from heart attacks is 16 percent. For heart failure, it is 11 percent.

Like nearly all the hospitals evaluated, Pocono Medical Center's mortality rates were described as being within normal percentages, though the actual number or percentage of these deaths were not specified.

At the same time, scoring well on the core measures does not necessarily translate into fewer patient deaths.

For example, St. Vincent's Hospital in New York City's Greenwich Village gave virtually all its heart attack patients aspirin and beta blockers upon both admission and discharge. But its patients' rate of death from heart attack was no different than the national average.

"I think the lesson to be learned is that we have a ways to go before we really measure quality," Davis said.